HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 a SCO Permit Number:
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Building Permit Application _2
Planning and Development Services MAR 20.16
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENTaLOCATION �a
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Address: 'U3t �,�e62c� L..
Legal Description: Loc K 5
Property TaxID#: 40� 0d� 6y��® `��� ��� ` 7 Lot No.
Site Plan Name: _ Block No.
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Project Name: 1fc17 &1e1 te
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CDNSTRUCTI,ON INFORIUTATIOIV
Additionalwork to be performed under this permit–check allthat appy:
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
Electric >< Plumbing _Sprinklers _`Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ bl✓3 0• L9y Utilities: —Sewer _Septic Building Height:
OVI%NER/LESSEE ;CONTRACTOR r
Name \.Layoj;_. G @Z"l Name: IQ>A 5 Z) r`r8
Address: k1 (Pi1 Company: &SSazj oo�b Lib\yy
City: State:Yr Address: 90 f�>O>a N**�
Zip Code: 3�"1 Fax: City: 'Poiz.-s SR L,1 c o- State: S�7,
Phone No. y- �0 D '_�� Zip Code: LV�7) V S Fax: 'Y).), P.:4 of –tj
E-Mail: j– NNoT�efL�l $A tl oo , Com. Phone No '112 T 3 �;
Fill in fee simple Title Holder on next page (if different E-Mail b' 0 tlao ,Ccs
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMAT[bN
DESIGNER ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a-full concurrency review:room additiops,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney`before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Age . Signature of ontr.-aetor/ticense Holder
.,90....•x-•` b,• •;Ty.
STATE OF FLORI - STATE OF FLORID °9...• r=
COUNTY OF a�< COUNTY OF
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The for oing instr ment was a knowledged befor u u Q The for oing instrument was acknowledged befo go9 o
this day of 20� by W E,= this day of O� , 20&-by
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(Name of person acknowledging) (Name of person acknowledging) -v-
(Signature
(Signature of N61ary Pu lic-State of Florid ) (Signature of Not Pub ic-State of Florid )
Personally Kn OR Produced Identification/ Personall own OR Produced Identification
Type of Identificati Type of Iclent'•'c tion
Produced � `� Produced
Commission No. (Seal) Commission o. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.